HomeMy WebLinkAboutSeptic New 110 Brookfield Street a�✓/��iti�Ji /7 — 7/
TOWN OF SOUTH I D R - f W N SO
BUILDING DEPARTMENT
South Windsor, Connecticut
Application for Permit to Install or Repair Individual Sewage Disposal System J
Application No.�� ;7/ /
TO THE BUILDING DEPARTMENT: Date—fT 19 -7L
A permit is requested for repair or construction of an individual sewage disposal system concerning which the
following information is submitted:
1. Owner of Property f% 9 �"-2N Address of Owner
2. Location of Property f zr 5 1 Lot. No.
3. Type of Structure No. of Bedrooms
(Dwelling,Commercial Building,Store,etc.)
4. Number of Families or Persons to Occupy Premises_
5. Plumbing Fixtures: Water Closets Urinals Lavatories Bathtubs
Showers Kitchen Sinks Laundry Tubs Garbage Grinder Other
6. Liquid Capacity of Septic Tank Fxisrl^16- Material of Septic Tank
7. Soil Conditions: Type of Soil Maximum ground water table
(Sand,Gravel,Clay,etc.)
8. If not served by public water supply: Distance from Owner's well from adjacent wells
9. Distance to nearest water course, drainage ditch, storm drain or embankment
10. Percolation Tests: Time for 1" drop in soil test //T Classification of soil
11. Minimum square feet of effective seepage area required
3 S � OCT12. Leaching System: Number of trenchesTW o (2 F-
) Length /50 r Width S .4 2 T. Total
Other `
Signature
(LicensedInstaller) y L r P�+AT
(Sketch showing all minimum distances and other details required below)
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Permit Issued �, �' � 19 By
l Installation Completed, Inspected and Approved S—" 19 <" By
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76' 170
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NOTE: S OU T N ►.ti i�V J'���}^� ?` i_i_I,�1 �t�P� �ON T PO(
'See CONO4AMIT 17-71. i O ATi ON ,moo (3a008& ST+2eEfT
SEPTA ASAAA09
IJ{� i I: aS 2t9�71 PERMI 1 71-Z PtPE
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